From Our Correspondents.

The Jenner Lecturer this year was Sir Peter Medawar. In the title of his lecture he posed the question 'Is inoculation against cancer theoretically possible?' and he started immediately by expressing the opinon that he thought it should be. He presented this complex subject with great lucidity, beginning with a graph showing the relationship between the incidence of breast cancer and the age of first pregnancy and showing that as the age advances so does the incidence of breast cancer. He explained it as follows?malignant cells contain active substances of genetic origin which are antigenic and are also present in normal embryo cells. These substances become dormant as the


From Our Correspondents
The Jenner Lecture The Jenner Lecturer this year was Sir Peter Medawar. In the title of his lecture he posed the question 'Is inoculation against cancer theoretically possible?' and he started immediately by expressing the opinon that he thought it should be.
He presented this complex subject with great lucidity, beginning with a graph showing the relationship between the incidence of breast cancer and the age of first pregnancy and showing that as the age advances so does the incidence of breast cancer. He explained it as follows?malignant cells contain active substances of genetic origin which are antigenic and are also present in normal embryo cells. These substances become dormant as the embryonic cells mature. When a tissue becomes malignant these substances are reawakened. The antibodies produced in the pregnant mother by embryonic antigen are capable of protecting against cancer but the timing of the antigen challenge is critical in relation to cancer. Several of the existing wards will be emptied into the new block when completed, and then the old buildings will be demolished to await the development plans for Phase II.
The concept of a ward block originated five or six years ago, and plans have been slowly maturing on its structure and contents ever since. A model is being prepared for public display within the next few weeks to illustrate how the development will appear.
It is hoped that it will generate considerable interest.
A natural result already is that several opinions are circulating that it is not just the wards that need replacing, but that many other features at Frenchay Hospital need to be upgraded, and that the existing plans could stimulate a fresh look and further thought. The whole concept of hospital buildings is presently undergoing a change and a flexible approach may be needed. Time again will tell.
The second item is the proposed demolition of the stable block for which an application has already been lodged with the local district council. For those interested in local history, this building is part of the original house curtilage built about 200 years ago in the fine parkland, which now constitutes the grounds of Frenchay Hospital. The stable block in fact is of interest in that it has a high arched entrance to the inner courtyard for the passage of a coach and four, a style almost unique in the area. There are also some interesting round windows. The building is in local pennant stone, quarried in the neighbourhood, and having an attractive reddish-grey colour in it. Unfortunately the building has been neglected, and although it still serves a useful function in housing the farming and gardening equipment, the Authority regard it as beyond repair. However  Why should this be? The concept of clinical review and audit is especially fashionable now. Surely even sophisticated biochemistry and the impressive noninvasive body images of today themselves require some check. Why not, if perchance the worst occurs, in the post-mortem room? There are pathologists available for such things. Is it that the task of asking relatives for the ultimate pathological test is too taxing? If any examination was really necessary, surely this one cannot be neglected. Even colleagues with the chromatograms, monoclonal antibodies, antibiotic discs, and Coulter counters would agree about the importance of this last investigation. Maybe bothhospitalcliniciansand general practitioners ought to make different use of their laboratory based colleagues. We are perfectly willing to oblige them, and even to arrange the subsequent Clinico-Pathological Conferences.

Holistic Medicine
Isn't it fascinating how old terms keep recurring?
Hippocrates was the first to suggest that man should be looked at as a whole and somehow over the course of centuries this concept has been lost?only to be regained at the end of the twentieth century! We all know that much has been gained by our spell of scientific enquiry and by the understandable need to simplify problems by dividing them into selfcontained small units; but much has been lost. We now have specialists who are expert in the diseases of parts of the body, a liver specialist, a cardiologist and so on. Even specialties like paediatrics are subdividing into paediatric neurology and paediatric endocrinology. Is all this gain? Solzhenitsyn in Cancer Ward says 'But the patient's organism isn't aware that our knowledge is divided into separate branches. You see the organism isn't divided'. He goes on to suggest that the doctor ought to be an allrounder only to be met by Dontsova's despair at the seemingly impossible task of amassing the sum of knowledge gained by the specialists. Perhaps specialism has gone too far for most patients.
It is therefore perhaps not surprising that holistic medicine has reappeared. The suggested rationale behind its reappearance is the need to look at patients needs in a more global way rather than the reductionist approach of the specialist. How much are the patients fears contributing to his illness? How much influence is his mother in law having on his reaction to his symptoms and so on. Man or his parts cannot be viewed in isolation. One other 'holistic' concept is that for most illnesses only part of the organism is 'unwell'; perhaps we, as doctors, should be concentrating at least as much on the remaining (larger) part of the organism that is healthy. Ought we to be encouraging this larger part of the patient towards better health and therefore aiding the rest of the body in its attempt at homoeostasis. Is all this nonsense or are we painfully being encouraged to reassess and overcome our prejudices and our traditional teaching? General practice has traditionally approached patients in a holistic way. But even general practitioners have much to learn from the new discipline of holistic medicine; we need to broaden our concepts and to consider embracing such techniques as relaxation, meditation, diet and even visual imaging to help our patients manage their illhealth. 'Therefore, doctor, might it be possible for us to rewrite that sentence in your report as follows: "This situation was as near normal as black (or grey) is from white (or grey)." We can? Thank you, doctor. I have no further questions, my Lord.' G.M.S.